Overall Project Summary/Abstract North Dakota is a large land mass, low population, agricultural state with only 755,393 citizens occupying over 68,976 square miles. Thirty-six (36) of North Dakota?s 53 counties retain a Federal designation as ?Frontier Counties? since they contain less than 6 people per square mile. A result of this environment was that the system of higher education offered very limited opportunity for undergraduates to participate in biomedical research. The ND INBRE addressed this problem starting in 2005 and has now successfully established undergraduate research at primarily undergraduate institutions (PUIs), tribal colleges (TCUs), and at the University of North Dakota, a research intensive university (RIU) and academic home of the ND INBRE. To date, over 1,000 students have participated in undergraduate research, including 189 American Indian students. Over 85 M.D.?s and 77 Ph.D.?s are in training or postgraduate service, including 8 American Indian M.D.?s and 5 American Indian Ph.D.?s. Over 120 other graduates have entered the healthcare workforce. The undergraduate researchers have produced and presented over 775 posters. The PUIs and TCUs have year-round research on their own campuses. The ND INBRE has also provided over $5,000,000 in infrastructure to the PUI, TCU, and RIU partners over the last 5 years. The ND INBRE has also promoted STEM in the middle and high schools of ND by providing registration fees for students and their schools to compete in the Science and Engineering Fair. To date, over 3,000 middle and high school students have taken advantage of this support. In 2018, one student was awarded a scholarship valued at $250,000. These efforts clearly fulfill the 4 primary goals of the INBRE program; 1) to provide research opportunities for students from PUIs, CCs and TCUs and to serve as a pipeline for these students to pursue health research careers; 2) to enhance science and technology knowledge of the state's workforce; and, 3/4) to build and increase the research base and capacity to faculty, postdoctoral fellows and graduate students at participating institutions. The ND INBRE intends to continue to build upon this firm foundation of success.